P1284: THE TEAR CYTOKINE PANEL IS A USEFUL BIOMARKER FOR EARLY DIAGNOSIS AND SEVERITY-EVALUATING OF OCULAR CHRONIC GRAFT-VERSUS-HOST DISEASE
Authors: Xianjing Cheng, Ruihao Huang, Wei Fan, Lingyu Zeng, Tao Wu, Rongdi Yuan, Xiaoqi Wang, XI Zhang
Journal: HemaSphere (2023)

Topic: 22. Stem cell transplantation - Clinical Background: Chronic graft-versus-host disease (cGVHD) is a common complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), affecting 30–70% of patients after allo-HSCT. Sixty to ninety percent of cGVHD patients suffer from ocular chronic GVHD (ocGVHD), which is characterized by new-onset dry, “gritty”, or painful eyes, cicatricial conjunctivitis, keratoconjunctivitis sicca, and confluent areas of punctate keratopathy, significantly affecting patients’ quality of life. Nevertheless, the clinical diagnosis of ocGVHD relies heavily on observing symptoms and clinical signs. Treatment is typically initiated during the symptomatic stage, by which time the damage to the ocular tissues may be irreversible. Consequently, it is crucial to investigate methods of early diagnosis for early intervention. Aims: To further investigate the immune system’s predictive role in ocGVHD early diagnosis and identify more sensitive biomarkers to verify the consistency of various ophthalmic indices. Methods: The inclusion criteria were set as post-allo-HSCT patients between the ages of 18 and 60 who were willing to participate in the study. The visual acuity, ocular pressure, slit lamp biomicroscopy, Ocular Surface Disease Index (OSDI) score, Schirmer’s test without anesthesia, corneal fluorescein staining (CFS) score, and fluorescein tear breakup time (FTBUT) were evaluated. The tear sample was collected via Schirmer’s strips, The concentrations of sixteen tear serum constituents (Interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17, CX3CL1, CXCL9, CXCL11, CXCL13, CCL11, CCL17, CCL19, CCL21, CCL23, interferon-gamma (IFN), and B-cell activation factor (BAFF) were tested using ELISA panel. Qualitative data were compared with the chi-square test. The Spearman test was used to analyze correlations. Results: A total of 26 post-allo-HSCT ocGVHD patients (38±11y; range 19-57y) and 27 patients without ocGVHD (34±9y; range 20-52y) were recruited. Between patients with and without ocGVHD, there were significant differences in ocular surface parameters (p < 0.0001). Patients with ocGVHD had elevated levels of the tear cytokines IL-8, IFN-γ, CXCL9, and CCL17. IL-10 and CCL19 levels were lower. Receiver operating characteristic (ROC) analysis confirmed the diagnostic potential for ocGVHD. The correlation analysis between tear cytokine levels and ophthalmic indices showed that 3 cytokines were correlated with ophthalmic indices: IL-10, IFN-γ and CXCL9, indicating the superior diagnostic capabilities and correlation with ocGVHD severity. Summary/Conclusion: The study revealed significant differences in tear cytokine levels in patients with and without ocGVHD.IL-8, IL-10, IFN-γ, CXCL9, CCL17, CCL19 are promising potential biomarkers in early ocGVHD diagnosis.IL-10, IFN-γ and CXCL9 levels could evaluate the severity of ocGVHD. In addition, large-scale prospective studies are warranted to confirm our findings.Keywords: Graft-versus-host disease (GVHD)